Hypnosis and Trichotillomania

A young woman comes to one of our offices. She is new in her career, just starting out. She is in graduate school and has this problem: she pulls out her hair. It happens when she is on the phone, when she watches television, but especially when she is writing papers. Sometimes the pulling gets so intense that she takes many more hours to complete her work than she would like. Not to mention, she is doing damage to her scalp that may prove permanent.

The young woman says she has been pulling out her hair since she was a teenager, for about ten years now. She has stopped at times, once for two-thirds of a year, but always started again. She has tried support groups and various other treatments, but with no consistent success. Now, she is ready to try what we offer: hypnosis.

Hypnosis. The word tends to get many strong reactions. It conveys mystery, magic, and the unknown to some. To others it conveys quackery, showmanship and nonsense.

In this article, we want to provide some Information about hypnosis-who can use it, how it works, and what it feels like to experience it. This will be a useful introduction to newsletter readers interested in how hypnosis can help people with trichotillomania.

We are both hypnotherapists with private practices in New York City. In our practices we use hypnosis to help people stop smoking, lose weight, overcome phobias, and cope with insomnia and stress. Research also shows hypnosis to be a very successful treatment for pain management and fast healing.

Often, we use hypnosis to work with people who have trichotillomania. We have found it to be a very effective method of treatment for women, men and children. Both of us have gotten good results, with Naomi finding that in her practice, some 65 percent of people (ED. NOTE: self-selected by wanting to use hypnosis to begin with) were able to stop pulling completely for from one month to several years.

Such results can be possible with hypnosis alone, or in combination with other treatments such as support groups, medication and behavioral modification. Results vary using hypnosis. Successes are sometimes dramatic! (ED. NOTE: Again, be aware that even though hypnosis is a great tool for some, it may not work for you. A good outcome is usually the result of a high motivation level and easy trance ability.)

You probably have many questions, some out of fear, some out of curiosity. Fearful questions about hypnosis often include: am I going to reveal my innermost secrets against my will? Am I going to embarrass myself or my loved ones? Am I going to remember things forgotten, or forget things I once knew? Will I get lost in a trance forever?

And, of course, the classic question: am I going to quack like a duck or cluck like a chicken?

These are good questions, and ones we answer regularly in our practices. To start with the easiest questions first, be assured there will be no quacking or clucking. This sort of behavior only happens with stage or television hypnotists.

Hypnotherapy clients typically sit in a chair quietly, keeping any secrets that they would like to stay secrets to themselves. They listen to our words, go into trance and reap the benefits of their work.

Two of the most common hypnotic phenomena are time distortion and forgetting. People usually feel the time spent in trance was much shorter than it actually was. Many people do not recall all that was said to them during the trance, or else they remember everything clearly at first and then forget. This has no impact on the effectiveness of the trance and is similar to forgetting the details of a dream when you awaken.

Some people think they have fallen asleep and remember nothing. This, too, does not affect the trance. The hypnotic trance can be light, deep or intermittent.

People also have curious questions: can anyone go into trance? How will I know if I am in trance? What does it feel like? What will I look like? And, of course, what if it doesn't work?

Anyone can go into trance, although there is some evidence that people with particular types of brain damage may not be capable. Otherwise, with the help of a skillful hypnotherapist, everyone can experience useful trance.

Trance is a common, natural phenomenon. You are familiar with what it feels like if you know how it feels to drift off towards sleep but not quite be there, or how it feels when you are supposed to be concentrating on a conversation but your mind is off pondering the choices for dinner that evening.

If you have ever meditated, you know what it feels like to be in trance. Prayer and biofeedback, like hypnosis, access alpha and theta brain waves. These brain waves are associated with states of high focus, concentration, receptivity and creativity.

Historically, hypnosis has been induced by rhythmic sounds and repetition of words. Other methods use concentrated eye focusing on a single spot or on a mental image. There are many ways that can allow a person to easily enter the hypnotic state.

Trance phenomena include slower heart rate and breathing, relaxation of muscles and a decrease in the eye's blinking reflex. Movements become smaller, less smooth. It is worth noting that some people experience these phenomena in reverse, breathing more quickly while in trance, for example.

Generally, the more you experience hypnosis, the more you learn about your own signs of trance. For Paul, entering trance is accompanied by his throat going dry and his vision blurring slightly at the edges. Naomi feels a dropping down or open feeling in her chest.

Nervous or frightened people, or those who fear loss of control, may need one or two sessions to become more comfortable with the experience. To return to that woman we mentioned at the beginning of this article, we can trace her trance experience as an example of working with trichotillomania using hypnosis. This young woman came to see Paul for a half dozen scheduled sessions early in the spring of 1998.

In her first session, she gave background Information about her life. She discussed how and when and where she pulls, why she wants to stop, and how she would know when the treatment was successful. By the time she left the office, she had shared enough about herself for Paul to prepare a trance that would be helpful for her.

To do this, both Naomi and Paul worked with a trance that was first developed by Naomi, who was one of the first hypnotherapists in New York City to specialize in working with trichotillomania. We take the general trance text created by Ms. Sarna and adapt it to reflect what we think will work best for the individual client. In the case of this woman, Paul made sure to include lots of stress reduction suggestions, since she was under a lot of pressure in her studies.

During the second session, the client goes into trance. The trance begins with the eyes open, but there is extra comfort in closing them after we start. The hypnosis session itself includes imagery, direct and indirect suggestions, humor and a variety of other techniques.

These methods enable the client's unconscious mind-the part of them that most clearly recalls the experience of living without pulling-to become more available to help their conscious mind cope with and resolve this issue. The client, not the hypnotherapist, always remains in control of his or her mind.

Since the unconscious, which is also responsible for dreams, is comfortable dealing in metaphors and stories, these are included in the trance. Many people describe the experience as a feeling of deep relaxation, sometimes almost like floating. For most, it is very pleasant.

In the third session, results are reviewed and the trance is repeated, with emphasis on areas that proved most helpful. For example, if the client recalls that one particular image from the trance popped up a few times during the week and kept them from pulling, that image will be focused upon and possibly expanded.

If someone has not seen improvements by this point, it may be because they are afraid of losing something that has been important to them for so long. The hypnotherapist must deal with this issue for successful and satisfying results to occur. Some people need to give themselves permission to stop pulling.

By the fourth session, in this woman's case, the pulling had stopped completely. If it had not, the work could be moved into other trances and directions. Since it had worked well for this client, the task became to reinforce her success with self-hypnosis techniques.

Self-hypnosis is similar to the sort of hypnosis already described, but it can be done alone. Clients often start by using the techniques for minutes at a time and can stay at that level or build up to as much as a half an hour a day. The consistency of the work is most important for good results. Those who use it regularly can reinforce or even augment the hypnotic work they have begun in our offices.

Many self-hypnosis techniques are simple. One of the easiest-breath counting-allows the mind to focus only on numbers and breathing, letting go of all other stimuli. Clients report it can be the most relaxing and refreshing part of their day.

Eventually, this can even be used "on the spot" to ward off a pulling urge, which for many people with particularly tough-to-beat trichotillomania is a major benefit. This can also be combined with behavioral modification techniques such as fist-clenching. (ED. NOTE: fist-clenching is an aspect of Habit Reversal Training, which includes deep diaphragmatic breathing, relaxation, and a competing muscle response, all three to be done instead of pulling.)

In the case of the client we have discussed, through the work that began in the office and that she continued on her own, according to the last word from her she was able to stop pulling and stay stopped. We both have worked with others who find coming in for a tune-up every one, three or six months helps keep them stopped. Still others reduce their pulling over time, making major progress without ever stopping completely.

Each case is different, and trichotillomania can come back, but if hypnosis has worked in the past, with the help of a tune-up, it should continue to work.

For those who have to cope with trichotillomania, each day can be a struggle. Hypnosis is one of the methods that can end or lessen that struggle. For those who are uncomfortable with medication, who have failed to see results with strictly behavioral approaches, or who just seek to add another tool to their coping techniques, hypnosis is an option worth considering.

Naomi Sarna, CSW, LSW is a New York and New Jersey certified social worker with a private practice in psychoanalysis, psychotherapy and hypnotherapy in New York City. She is a training and supervising psychoanalyst. She is former dean of students at the New Jersey Center for Modern Psychoanalysis. She is a graduate of the Hunter College School of Social Work. She is also a certified birth assistant. She can be reached at 212-727-7967.

Paul Weinberg, CSW, LSW is a New York and New Jersey certified social worker with a private practice in psychotherapy and hypnotherapy. He is a graduate and board member of the New York Milton H. Erickson Society for Psychotherapy and Hypnosis, for which he coordinated a major conference this spring. He is a candidate for certification in psychoanalysis at the New Jersey Center for Modern Psychoanalysis. He is a graduate of the Columbia University School of Social Work. He can be reached at 212-769-4379.